Differences in response to systemic drug therapy between bone metastases and visceral lesions in advanced non-small cell lung cancer
Objective Systemic drug therapy(SDT)plays a crucial role in the control of advanced non-small cell lung cancer(NSCLC).This study aims to explore the differences in response to systemic drug therapy between bone metastases and visceral lesions in patients with advanced NSCLC and the relevant factors in clinical characteristics and gene expression.Methods This study collected clinical data of patients with bone metastases treated by NSCLC in the Musculoskeletal Tumor Center,Peking University People's Hospital,from January 2010 to December 2020.Differences in the progression of bone metastases and visceral lesions after SDT reflected the responsiveness of the lesions to SDT.The differences were validated using gene expression data from GSE76194 bone metastases and primary lesions in the Gene Expression Omnibus(GEO)database.Results The optimal rate of progression of bone metastases and visceral lesions after systemic drug treatment was 79.7%and 20.3%,respectively(P＜0.05).The results of logistic regression analysis showed that the mutation status of epidermal growth factor receptor(EGFR)(OR = 6.76,P = 0.009)and the location of visceral metastases before drug treatment(OR = 0.078,P = 0.001)were independent factors affecting the difference in treatment response.Cox regression analysis showed that a history of smoking(HR = 4.4,P = 0.0027),using targeted drugs only(HR = 2.94,P = 0.0055),the location of visceral metastases before systemic drug treatment(HR = 0.37,P = 0.011)were independent prognostic factors affecting the priority progression of bone metastases.Gene expression data analysis screened 938 differentially expressed genes,and GSEA analysis of the differentially expressed genes significantly enriched four drug resistance-related pathways.Conclusions In patients with advanced NSCLC,there are significant differences in response to systemic drug therapy between bone metastases and visceral lesions.There is an upregulation of drug resistance-related pathways in bone metastases.Bone metastases in patients with EGFR mutations have a poorer response to SDT than extraperitoneal visceral lesions.It is recommended to actively take local treatment for bone metastases with poor response to SDT in advanced NSCLC.
NETL
NSTL
万方数据
维普
